Creating a Positive Workplace

Skilled Nursing Facilities (SNFs) in California have a unique set of rules and regulations to comply with. The heavy oversight of SNFs can produce a very stressful workplace for employees. SNFs consequently experience very high turnover rates relative to other industries. For example, in 2012, despite pay increases across the industry, the turnover rate for nursing facilities in California was as high as 57.6% for some regions. That is almost 20% above the national average of 38.3%. [1] High turnover rates can result in a decline in quality of resident care. In order to combat staff turnover, it is important for facilities to promote a positive and supportive work environment for its employees.

Staff Attitudes Reflect Leadership

Often times, employees learn what is important in a work environment from their supervisors. Employees look to their department heads for cues on how to behave in the workplace.

Leadership should always:

Be respectful and honest – Showing staff that you respect them can make them much more receptive to criticism or corrections.

Use mistakes to coach and develop – While some mistakes may result in disciplinary action, all mistakes can be used as learning experiences, not only for a single employee, but for the facility generally. Make sure that when correcting a mistake, always give constructive criticism and try to end all conversations on a positive note.

Be open and available – Facility staff should always feel that they can come to you with issues. Having a true open door policy (not just leaving your office door physically open) can make facility operations transparent, thus leading to earlier identification of issues.

Be trustworthy – Facility staff should feel that they can trust you with any information that they disclose. Making staff feel comfortable is a very critical role in management.

Encourage Staff to Provide Resident-Centered Care

The goal of every facility should be to provide the best care to its residents. When employees feel that their work is appreciated, they are more likely to take greater pride in what they do. Increased pride in performance may lead to a decrease in resident falls, medication errors, and complaints, among other things that take away from quality health care delivery. It is leadership’s job to ensure that employees know that their work matters.

Reducing Turnover

Consistency is crucial to providing the best care for residents. High turnover rates in skilled nursing settings can be detrimental to providing that consistency. There are many factors that lead to high turnover rates, some controllable and others uncontrollable. Among controllable factors is staff satisfaction. Creating an enjoyable employee experience can vastly improve staff retention rates.

360° reviews – Allow staff to review their managers as well as the staff members that they manage on a regular basis.

Prevent Whistleblowers

Disgruntled employees can become liabilities for the facility if they do not communicate issues they have identified to the facility for correction prior to ending employment. Qui tam lawsuits allow a private person to sue a person or organization that knowingly submits false claims to the federal government. The law protects qui tam plaintiffs who are "demoted, suspended, threatened, harassed or in any other manner discriminated against in the terms and conditions of employment” for acts done in furtherance of filing a claim under that act. If the qui tam lawsuit is successful, the whistleblower (known as a "relator") will also be entitled to a percentage of the government's total recovery. For example, in the case of Momence Meadows Nursing Center in Illinois, two former employees were granted $7 million after the Facility was found guilty of mistreating elderly and disabled residents, Medicare/Medicaid fraud and billing government sponsored programs for medically unnecessary, nonexistent or substandard services. In order to help prevent these types of scenarios it is important for the facility to develop a culture where open communication is encouraged and perform exit interviews that solicit candid feedback.